Skip to main content
Key Specialties
Cardiology Diabetology Endocrinology Gastroenterology Geriatrics and Gerontology Gynecology and Obstetrics Hematology Infectious Disease Internal Medicine Nephrology Neurology Oncology Pediatrics Respiratory Medicine Rheumatology Surgery
Congress Coverage
2024 ACC Congress 2023 ESMO Congress 2023 EASD Congress 2023 ERS Congress 2023 ESC Congress
Clinical Collections
Advances in Alzheimer’s

Keynote webinar | Spotlight on medication adherence

LIVE: Thursday 27th June 2024, 18:00-19:30 (CEST)
Join our expert panel to discover why you need to understand the drivers of non-adherence in your patients, and how you can optimize medication adherence in your clinics to drastically improve patient outcomes.
ADVANCED SEARCH
Log in
Top
Scandinavian Journal of Trauma, Resuscitation and Emergency Medicine
Published in: Scandinavian Journal of Trauma, Resuscitation and Emergency Medicine 1/2016

Open Access 01-12-2016 | Original research

Association between trauma and socioeconomic deprivation: a registry-based, Scotland-wide retrospective cohort study of 9,238 patients

Authors: Alasdair R. Corfield, Danny F. MacKay, Jill P. Pell

Published in: Scandinavian Journal of Trauma, Resuscitation and Emergency Medicine | Issue 1/2016

Login to get access

Abstract

Background

Trauma remains a leading cause of morbidity and mortality in the UK and throughout the world. Socioeconomic deprivation has been linked with many types of ill-health and previous studies have shown an association with injury in other parts of the world. The aim of this study was to investigate the association between socioeconomic deprivation and trauma incidence and case-fatality in Scotland.

Methods

The study included nine thousand two hundred and thirty eight patients attending Emergency Departments following trauma across Scotland in 2011-12. A retrospective cohort study was conducted using secondary data extracted from the national trauma registry. Postcode of residence was used to generate deciles using the Scottish Index of Multiple Deprivation. The incidence rate ratio (IRR) was calculated to allow comparison of incidence of trauma across SIMD deciles. For mortality, observed: expected ratios were obtained using observed mortality in the cohort and expected deaths using probability of survival based on Trauma and Injury Severity Score (TRISS) method.

Results

Compared with the most deprived decile, the least deprived had an incidence rate ratio (IRR) for all trauma of 0.43 (95 % CI 0.32–0.58, p < 0.001). The association was stronger for penetrating trauma (IRR 0.07, 95 % CI .01–0.56, p = 0.011). There was a significant interaction between age, gender and SIMD. For case fatality, multivariate logistic regression showed that, severity of trauma (ISS > 15) OR 18.11 (95 % CI 13.91 to 23.58) and type of injury (Penetrating versus blunt injury) OR 2.07 (95 % CI 1.15 to 3.72) remain as independent predictors of case fatality in this dataset.

Discussion

Our data shows a higher incidence of trauma amongst a socioeconomically deprived population, in keeping with other areas of the world. In our dataset, outcome, as measured by in-hospital mortality, does not appear to be associated with socioeconomic deprivation.

Conclusion

In Scotland, populations living in socioeconomically deprived areas have a higher incidence of trauma, especially penetrating trauma, requiring hospital attendance. Case fatality is associated with more severe trauma and penetrating trauma, but not socioeconomic deprivation.
Appendix
Available only for authorised users
Literature
1.
Lopez AD, Mathers CD, Ezzati M, Jamison DT, Murray CJL, editors. Global burden of disease and risk factors. New York: The World Bank and Oxford University Press; 2006.
2.
Patton GC, Coffey C, Sawyer SM, Viner RM, Haller DM, Bose K, et al. Global patterns of mortality in young people: a systematic analysis of population health data. Lancet. 2009;374:881–92.CrossRefPubMed
3.
National Audit Office. Major Trauma care in England. London: The Stationery Office; 2010.
4.
Chaira O, Cimbanissi S. Organized trauma care: does volume matter and do trauma centers save lives? Curr Opin Crit Care. 2003;9:510–4.CrossRef
5.
The Royal College of Surgeons of England and the British Orthopaedic Society. Better Care for the Severely Injured. London: Royal College of Surgeons of England; 2000.
6.
Royal College of Surgeons of England Report of the working party on the management of patients with major injury, London: Royal College of Surgeons of England; 1988.
7.
National Audit Office. Major trauma care in England. London: National Audit Office; 2010.
8.
Lecky F, Woodford M, Yates DW. Trends in trauma care in England and Wales 1989–1997. Lancet. 2000;355:1771–5.CrossRefPubMed
9.
Lecky FE, Woodford M, Bouamra O, Yates DW, on behalf of the Trauma Audit and Research Network. Lack of change in trauma care in England and Wales since 1994. Emerg Med J. 2002;19:520–3.CrossRefPubMedPubMedCentral
10.
Findlay G, Martin IC, Carter S, Smith N, Weyman D, Mason M. Trauma: who cares? London: NCEPOD; 2007.
11.
Brohi K, Parr T, Coats T. Regional trauma systems. Interim guidance for commissioners. London: Royal College of Surgeons of England; 2009.
12.
Lendrum RA, Lockey DJ. Trauma system development. Anaesthesia. 2013;69 Suppl 1:30–9.CrossRef
13.
Lecky F on behalf of Trauma Audit Research Network. Changing the system: improving outcome from major trauma by developing a national system of regional major trauma networks. International Conference on Emergency Medicine. Hong Kong; 2014.
14.
American College of Surgeons. Advanced Trauma Life Support (9th edition). Chicago: 2012.
15.
16.
Mann NC, Mullins RJ, MacKenzie EJ, Jurkovich GJ, Mock CN. Systematic review of published evidence regarding trauma system effectiveness. J Trauma. 1999;47:S25–33.CrossRefPubMed
17.
Celso B et al. A systematic review and meta-analysis comparing outcome of severely injured patients treated in Trauma Centers following the establishment of trauma systems. J Trauma. 2006;60:371–8.CrossRefPubMed
18.
19.
Acheson D. Inequalities in health: Report of an Independent Inquiry. London. 1998.
20.
Black D, Morris J, Smith C, Townsend P. Inequalities in health: report of a Research Working Group. London: Department of Health and Social Security; 1980.
21.
NHS Health Scotland. The impact of Keep Well: an evaluation of the Keep Well programme from 2006 to 2012. Edinburgh: NHS Health Scotland; 2014.
22.
Burrows S, Auger N, Gamache P, Hamel D. Individual and area socioeconomic inequalities in cause-specific unintentional injury mortality: 11-year follow-up study of 2.7 million Canadians. Accid Anal Prev. 2012;45:99–106.CrossRefPubMed
23.
Hanna CL, Laflamme L, Bingham CR. Fatal crash involvement of unlicensed young drivers: county level differences according to material deprivation and urbanicity in the United States. Accid Anal Prev. 2012;45:291–5.CrossRefPubMed
24.
Spoerri A, Egger M, von Elm E, Swiss National Cohort S. Mortality from road traffic accidents in Switzerland: longitudinal and spatial analyses. Accid Anal Prev. 2011;43:40–8.CrossRefPubMed
25.
Park K, Hwang SS, Lee JS, Kim Y, Kwon S. Individual and areal risk factors for road traffic injury deaths: nationwide study in South Korea. Asia Pac J Public Health. 2010;22:320–31.CrossRefPubMed
26.
27.
Association for the Advancement of Automotive Medicine. The abbreviated injury scale. 1990 Revision. Des Plaines: AAAM; 1990.
28.
Baker SP, O’Neil B, Haddon W, Long WB. The Injury Severity Score: a method for describing patient with multiple injuries and evaluating emergency care. J Trauma. 1974;14:187–96.CrossRefPubMed
29.
Champion HR, Sacco WJ, Copes SW, Gann DS, Gennarelli TA, Flanagan ME. A revision of the trauma score. J Trauma. 1989;29:623–9.CrossRefPubMed
30.
31.
Scottish Government Health Department. Scottish Index of Multiple Deprivation 2012. Edinburgh; 2012.
32.
33.
Zarzaur BL, Croce MA, Fabian TC, Fischer P, Magnotti LJ. A population-based analysis of neighborhood socioeconomic status and injury admission rates and in-hospital mortality. J Am Coll Surg. 2010;211:216–23.CrossRefPubMedPubMedCentral
34.
Chakravarthy B, Anderson CL, Ludlow J, Lotfipour S, Vaca FE. The relationship of pedestrian injuries to socioeconomic characteristics in a large Southern California County. Traffic Inj Prev. 2010;11:508–13.CrossRefPubMed
35.
Kristensen P, Kristiansen T, Rehn M, Gravseth HM, Bjerkedal T. Social inequalities in road traffic deaths at age 16–20 years among all 611 654 Norwegians born between 1967 and 1976: a multilevel analysis. Inj Prev. 2012;18:3–9.CrossRefPubMed
36.
Fleury D, Peytavin JF, Alam T, Brenac T. Excess accident risk among residents of deprived areas. Accid Anal Prev. 2010;42:1653–60.CrossRefPubMed
37.
38.
Li X, Sundquist S, Johansson SE. Effects of neighbourhood and individual factors on injury risk in the entire Swedish population: a 12-month multilevel follow-up study. Eur J Epidemiol. 2008;23:191–203.CrossRefPubMed
39.
Chen HY, Ivers RQ, Martiniuk AL, Boufous S, Senserrick T, Woodward M, et al. Socioeconomic status and risk of car crash injury, independent of place of residence and driving exposure: results from the DRIVE Study. J Epidemiol Community Health. 2010;64:998–1003.CrossRefPubMed
40.
Hanna CL, Hasselberg M, Laflamme L, Moller J. Road traffic crash circumstances and consequences among young unlicensed drivers: a Swedish cohort study on socioeconomic disparities. BMC Public Health. 2010;10:14.CrossRefPubMedPubMedCentral
41.
Males MA. Poverty as a determinant of young drivers’ fatal crash risks. J Saf Res. 2009;40(6):443–8.CrossRef
42.
Braver ER. Race, Hispanic origin, and socioeconomic status in relation to motor vehicle occupant death rates and risk factors among adults. Accid Anal Prev. 2003;35(3):295–309.CrossRefPubMed
43.
Yongchaitrakul T, Juntakarn C, Prasartritha T. Socioeconomic inequality and road traffic accidents in Thailand: comparing cases treated in government hospitals inside and outside of Bangkok. Southeast Asian J Trop Med Public Health. 2012;43(3):785–94.PubMed
44.
Ham OK. Psychosocial factors associated with lifetime experience of serious unintentional injury in South Korea. Public Health Nurs. 2008;25(1):37–45.CrossRefPubMed
45.
Hasselberg M, Laflamme L. Socioeconomic background and road traffic injuries: a study of young car drivers in Sweden. Traffic Inj Prev. 2003;4(3):249–54.CrossRefPubMed
46.
Steenland K, Halperin W, Hu S, Walker JT. Deaths due to injuries among employed adults: the effects of socioeconomic class. Epidemiology. 2003;14(1):74–9.CrossRefPubMed
47.
Bell N, Schuurman N, Hameed SM. A multilevel analysis of the socio-spatial pattern of assault injuries in greater Vancouver, British Columbia. Can J Public Health. 2009;100(1):73–7.PubMed
48.
Vestergaard P, Rejnmark L, Mosekilde L. Socioeconomic aspects of fractures within universal public healthcare: A nationwide case-control study from Denmark. Scand J Public Health. 2006;34(4):371–7.CrossRefPubMed
49.
Rhouma O, McMahon AD, Conway DI, Armstrong M, Welbury R, Goodall C. Facial injuries in Scotland 2001–2009: Epidemiological and sociodemographic determinants. Br J Oral Maxillofac Surg. 2013;51(3):211–6.CrossRefPubMed
50.
Conway DI, McMahon AD, Graham L, Snedker S, McCluskey K, Devlin M, et al. The scar on the face of Scotland: deprivation and alcohol-related facial injuries in Scotland. J Trauma Inj Infect Crit Care. 2010;68(3):644–9.CrossRef
51.
52.
Duckworth AD, Clement ND, Jenkins PJ, Will EM, Court-Brown CM, McQueen MM. Socioeconomic deprivation predicts outcome following radial head and neck fractures. Injury. 2012;43(7):1102–6.CrossRefPubMed
53.
Court-Brown CM, Aitken SA, Duckworth AD, Clement ND, McQueen MM. The relationship between social deprivation and the incidence of adult fractures. J Bone Joint Surg Am Vol. 2013;95(6):e321–7.CrossRef
54.
Carstairs V, Morris R. Deprivation and health in Scotland. Aberdeen: Aberdeen University Press; 1991.
55.
Chichester BM, Gregan JA, Anderson DP, Kerr JM. Associations between road traffic accidents and socio-economic deprivation on Scotland’s west coast. Scott Med J. 1998;43(5):135–8.PubMed
56.
Abdalla IM, Raeside R, Barker D, McGuigan DR. An investigation into the relationships between area social characteristics and road accident casualties. Accid Anal Prev. 1997;29(5):583–93.CrossRefPubMed
57.
Morrison JJ, McConnell NJ, Orman JA, Egan G, Jansen JO. Rural and urban distribution of trauma incidents in Scotland. Br J Surg. 2013;100(3):351–9.CrossRefPubMed
58.
Baker CC, Oppenheimer L, Stephens B, Lewis FR, Trunkey D. Epidemiology of Trauma Deaths. Am J Surg. 1980;140:144–50.CrossRefPubMed
59.
Wyatt JP, O’Donnell J, Beard D, Busuttil A. Injury analyses of fatal motorcycle collisions in south-east Scotland. Forensic Sci Int. 1999;104:127–32.CrossRefPubMed
60.
Injury prevention. British Medical Association: London: British Medical Association; 2001.
61.
Guyer B, Berenholz G, Gallagher SS. Injury Surveillance using hospital discharge abstracts coded by external cause of injury (E code). J Trauma. 1990;30:470–3.CrossRefPubMed
62.
Cameron PA, Gabbe BJ, McNeil JJ. The importance of quality of survival as an outcome measure for an integrated trauma system. Injury. 2006;37:1178–84.CrossRefPubMed
63.
Bouamra O, Wrotchford A, Hollis S, Vail A, Woodford M, Lecky F. A new approach to outcome prediction in trauma: a comparison with the TRISS model. J Trauma. 2006;61:701–10.CrossRefPubMed
64.
Tohira H, Jacobs I, Mountain D, Gibson N, Yeo A. Systematic review of predictive performance of injury severity scoring tools. Scand J Trauma Resusc Emerg Med. 2012;20:63.CrossRefPubMedPubMedCentral
Metadata
Title
Association between trauma and socioeconomic deprivation: a registry-based, Scotland-wide retrospective cohort study of 9,238 patients
Authors
Alasdair R. Corfield
Danny F. MacKay
Jill P. Pell
Publication date
01-12-2016
Publisher
BioMed Central
DOI
https://doi.org/10.1186/s13049-016-0275-7

Other articles of this Issue 1/2016

Scandinavian Journal of Trauma, Resuscitation and Emergency Medicine 1/2016 Go to the issue

Original research

Pre-hospital severe traumatic brain injury – comparison of outcome in paramedic versus physician staffed emergency medical services

Original research

Heel pressure ulcer, prevention and predictors during the care delivery chain – when and where to take action? A descriptive and explorative study

Original research

Development of a new Emergency Medicine Spinal Immobilization Protocol for trauma patients and a test of applicability by German emergency care providers

Original research

Surgical intervention for paediatric liver injuries is almost history - a 12-year cohort from a major Scandinavian trauma centre

Original research

Resuscitative endovascular balloon occlusion of the aorta for uncontrolled haemorrahgic shock as an adjunct to haemostatic procedures in the acute care setting

Original research

Prehospital volume resuscitation - Did evidence defeat the crystalloid dogma? An analysis of the TraumaRegister DGU® 2002–2012